S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE & RESEARCH
CENTRE, NAVSARI.

NURSING PROCESS
ON
ENTERIC FEVER

SUBMITTED TO SUBMITTED BY,

Ms. Dixita Surti Kataria Khushbukumari Pravinbhai

Assit. Professor F.Y.M.Sc Nursing
Child Health Nursing Child Health Nursing
SSAGCON SSAGCON

Submitted on:
31st-March-2023
 INTRODUCTION:
As a part of our clinical experience posting in New Civil Hospital Surat, I took care of
Janak Patil who was diagnosed as as congenital malformation- Bilateral cleft lip with cleft
palate. I selected this case in order to use this knowledge in my day to day clinical practice.

IDENTIFICATION DATA:
Name of the child: Janak Patil

Age: 10 Year
Sex: Male
Ward: Pediatric Ward
Name of the father: Rajesh Patil

Name of the mother: Priya Patil

Occupation of father: job

Occupation of the mother: Housewife
Date of admission:
Address: Udhna,Surat
Date of care started:
Date of care ended:

Diagnosis: Enteric Fever

CHIEF COMPLAINTS:
At the time of admission, the child was having complain of Fever with chills, Cough and
cold, Leg pain, Vomiting.
HISTORY OF PRESENT ILLNESS:

Baby is suffering from Enteric Fever condition so not able to breastfeeding.

HISTORY OF PAST ILLNESS:

In past baby was not have any illness or no complications occurred to baby at the time of birth so
no significant history was present in past.
 FAMILY HISTORY:
A. Type of family: Nuclear family
B. Diseases : there is no any disease in family members.
Sl. NAME AGE SEX RELATIONSHIP EDUCATION OCCUPATION HEALTH
No. WITH THE
PATIENT
1 Rajesh Patil 33 M Father Illiterate Job Healthy

2 Priya 30 F Mother Illiterate Housewife Healthy

Patil

3 Rohini 8 F Sister Student - Healthy

Patil

33 Year 30 Year

10 Year
8 Year

SOCIO ECONOMIC HISTORY:

They are living in Udhna,surat,having their own concrete pucca house in that 1 room and 1
kitchen with 1 doors and 2 windows. They are using SMC tap water for their drinking and daily
use purpose and close drainage system is present. They are using latrine for excretion. For the
entertainment television is there in the house and for medical facilities they are utilizing New
Civil Hospital Surat. The family is following Hindu religion and father is doing job, having
salary 18000/-per month.
PERSONAL HISTORY:
The child cant not take enough food child has good bowel and bladder pattern , rest and sleep is
normal .
BIRTH HISTORY:
Ante- Natal History: G2P2L2A0, she had taken 4 antenatal checkup and taken 2 dose of TT
vaccine.
Exposure to: during the time of pregnancy she didn’t suffered from to any exposure which is
harm for baby.
Natal History: she is having normal vaginal delivery, Birth weight: 3.5kg, place of delivery:-
New Civil Hospital Surat, no birth injuries, Gestational age: full-term gestational age 38+weeks.
Post- Natal History: no PPH and any complication occur, New born: color at birth was pink,
baby cried and breath immediately after birth.
IMMUNIZATION HISTORY:
Sl. No. VACCINES TIME OF ADMINSTRATION CHILD’S STATUS
1 BCG At birth Given
2 OPV—1 At birth Given
3 Hep-B At birth Given
4 DPT 6 Year Given
5 Hib 14 Week Given
6 PCV 14 Week Given
7 Rota Virus 4 Week Given
8 IPV 6 Week Given
9 MMR 24 Months Given
10 Vitamin A 16 Months Given
11 TT 10 Year Given

DIET HISTORY:
Type of feed: Oral Food
PHYSICAL EXAMINATION: (Head to Foot)

GENERAL APPEARANCE:
Posture: flexion of head and extremities extended legs and abducted thighs
Activity: normal, good
Body built: normal

SKIN:
Colors- pink
Texture- normal
Turgor- present
HEAD:
Shape: normal
EYES:
Lids: normal
Fixation on objects: absent
Sub-conjunctival hemorrhages:
absent Epicanthal Folds: present
Congenital cataract: absent
EARS:
Pinna in the line with eyes:
present Patent ear canal: normal
Pinna flexible: flexible pinna
NOSE:
Patent Nostril: nostril is patent
Nasal Discharge: absent
Nasal Septal Deviation: absent
MOUTH AND THROAT OBSERVATION:
Mouth:-
Cleft palate-Absent
Cleft lip- Absent

Supernumerary teeth- absent

Throat: symmetric while crying and normal

NECK: normal
CHEST:
Sternal Retraction: absent
Breast enlargement: absent
Wide spaced nipples: absent
LUNGS: normal functioning and no upper and lower tract infection present
HEART;
Patent Ductus Arteriosus
Apical pulse: can
felt Cyanosis: absent
Heart rate 90b/min
Heart Sound – Lub-dub
ABDOMEN

Bowel Sound: bowel sound heard

Visible Peristaltic waves: absent
MALE GENITALIA:
Testes: normal and distended
Deep Pigmented Scrotum:
present Congenital hydrocele:
absent Inguinal Hernia: absent
BACK AND RECTUM:
Spine: normal curvature
Imperforate Anus: absent
Patent and opening: normal
EXTREMITIES:
Full range of motion
Symmetry of extremities is normal
Dislocated hip is absent
Club foot, syndactyly, polydactyly is absent
NEURO MUSCULAR SYSTEM:
Cry is strong with loud voice
Sign of paralysis: absent
Turn head from side to side is present
INVESTIGATION:
Blood Culture Test
Widal test: - Positive
Blood culture – Positive for S enterica serovar Typhi in 60

USG abdomen

Urine examination
INVESTIGATION:
Sl. No. INVESTIGATION PATIENT VALUE NORMAL VALUE REMARKS
DONE
1 Hemoglobin 17.00 gm/dl 15-22gm/dl Normal
2 RBC 4.90 m/cmm 4.5-6.5m/cmm Normal
3 PCV 54.00% 45-62% Normal
4 MCV 99.00 fl 90-125 fl Normal
5 MCH 33.40 pg 30-45 pg Normal
6 MCHC 34.10 gm/dl 30-40 gm/dl Normal
7 RDW 14.50 % 10-26 % Normal

8 WBC 19000 /cmm 4000-10000/cmm Normal

9 Platelet 2.10 lacs/cmm 1.5-4.0 lacs/cmm Normal

Medical Management:

Paracetamol 1 gram BD
Oral or IV fluids
 TREATMENT:
Sl. TRADE PHARMAC DO ROUTE FRE ACTION INDICATION CONTRA- SIDE EFFECT NURSING
N NAME OLOGICA SE QUE INDICATION RESPONSIBILITY
O. L NAME NCY
1 Frusemi Inj. 6 Intrave BD Diuretic, It’s Helps your Diuretics Dizziness, Headache,  Assess patient
de Frusemid mg nous body get rid of hypersenssitivit Blurred vision, loss for signs and
e extra water by y, Electrolyte of appetite, symptoms of
increasing amount Imbalance, constipation, diarrhea infection prior
of urine you Hypovolemia to and
make. throughout
therapy.
 Instruct patient
to continue
taking
medication
around the
clock until
finished
completely,
even if feeling
better.
 Keep patient
hydrated
during therapy.
 Instruct patient
to report signs
of
hypersensitivit
y
 Follow the 10
rights of
medication.
 Assess patient
2 Ceftriax Inj 50 IV OD The class Susceptible bacterial Ceftriaxone is  Black, tarry for signs and
one Ceftriaxon 0 of infections of the contraindicated stools symptoms of
e mg medicine lower respiratory in patients with infection prior
known as known allergy to  chest pain
tract, skin and skin to and
cephalos structure, bone and the  chills
porin cephalosporin throughout
joint, acute otitis cough
antibiotic group of  therapy.
media, UTIs,
s.it works antibiotics  fever  Instruct patient
septicemia, pelvic
by killing to continue
bacteria inflammatory  painful or
disease (PID), taking
or difficult medication
preventin intraabdominal
urination around the
g their infections,
growth. meningitis,  shortness of clock until
uncomplicated breath finished
gonorrhea. Surgical completely,
 sore throat
prophylaxis. even if feeling
 sores, ulcers, better.
or white spots  Keep patient
on the lips or in hydrated
the mouth during therapy.
 swollen glands  Instruct patient
 unusual to report signs
bleeding or of
bruising hypersensitivit
y
 unusual  Follow the 10
tiredness or rights of
weakness medication.
3 Enalapri Tab. 0.5 Oral BD Enalapril The most important use it with  Blurred vision for signs and
l Enalapril mg is an labeled indications of caution in  confusion symptoms of
angiotensi enalapril are heart patients with infection prior
n failure and chronic aortic stenosis,  dizziness,
faintness, or to and
converting hypertension. myocardial throughout
enzyme Clinicians give infarction, stroke, lightheadedness
when getting up therapy.
(ACE) enalapril for both hypertrophic
inhibitor. It symptomatic and cardiomyopathy, suddenly from a  Instruct patient
works by asymptomatic collagen vascular lying or sitting to continue
blocking a congestive heart failure disease (e.g., position taking
substance to decrease mortality SLE), renal artery  sweating medication
in the and morbidity. It is also stenosis, and  unusual
around the
body that used for the treatment renal tiredness or clock until
causes of hypertensive impairment. weakness finished
the blood emergency and completely,
vessels to hypertensive urgency. Less common
even if feeling
tighten. better.
As a  Chest pain
 Keep patient
result,  cough producing hydrated
enalapril mucus
relaxes
during therapy.
 diarrhea  Instruct patient
the blood
vessels.  difficult or to report signs
This labored of
lowers breathing hypersensitivit
blood  fainting y
pressure
 fever or chills  Follow the 10
and rights of
increases  nausea medication.
the supply  sneezing
of blood
 sore throat
and
oxygen to  tightness in the
the heart. chest
 vomiting
 Disease condition :
Patent ductus arteriosus
Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. The heart problem
is present from birth. That means it is a congenital heart defect.
An opening called the ductus arteriosus is part of a baby's blood flow system in the womb. It usually closes shortly after birth. If it
remains open, it's called a patent ductus arteriosus.
A small patent ductus arteriosus often doesn't cause problems and might never need treatment. However, a large, untreated patent
ductus arteriosus can let oxygen-poor blood move the wrong way. This can weaken the heart muscle, causing heart failure and other
complications.
Treatment options for a patent ductus arteriosus include regular health checkups, medicines, and a procedure or surgery to close the
opening.

Symptoms
Patent ductus arteriosus symptoms (PDA) depend on the size of the opening and the person's age. A small PDA might not cause
symptoms. Some people don't notice symptoms until adulthood. A large PDA can cause symptoms of heart failure soon after birth.
A large PDA found during infancy or childhood might cause:

 Poor eating, which leads to poor growth.

 Sweating with crying or eating.
 Persistent fast breathing or breathlessness.
 Easy tiring.
 Rapid heart rate.

Causes
The exact causes of congenital heart defects are unclear. During the first six weeks of pregnancy, a baby's heart starts to form and
beat. The major blood vessels to and from the heart grow. It's during this time that certain heart defects may begin to develop.
Before birth, a temporary opening called the ductus arteriosus is between the two main blood vessels leaving a baby's heart. Those
vessels are the aorta and the pulmonary artery. The opening is necessary for a baby's blood flow before birth. It moves blood away
from a baby's lungs while they develop. The baby gets oxygen from the mother's blood.
After birth, the ductus arteriosus is no longer needed. It usually closes within 2 to 3 days. But in some infants, the opening doesn't
close. When it stays open, it's called a patent ductus arteriosus.
The persistent opening causes too much blood to flow to the baby's lungs and heart. Untreated, the blood pressure in the baby's lungs
might increase. The baby's heart might grow larger and get weak.

Risk factors
Risk factors for patent ductus arteriosus (PDA) include:

 Premature birth. Patent ductus arteriosus occurs more commonly in babies who are born too early than in babies who are born full term.
 Family history and other genetic conditions. A family history of heart problems present at birth may increase the risk for a PDA. Babies born
with an extra 21st chromosome, a condition called Down syndrome, also are more likely to have this condition.
 German measles during pregnancy. Having German measles, also called rubella, during pregnancy can cause problems in a baby's heart
development. A blood test done before pregnancy can determine if you're immune to rubella. A vaccine is available for those who aren't
immune.
 Being born at a high altitude. Babies born above 8,200 feet (2,499 meters) have a greater risk of a PDA than babies born at lower altitudes.
 Being female. Patent ductus arteriosus is twice as common in girls.

Complications
A small patent ductus arteriosus might not cause complications. Larger, untreated defects could cause:

 High blood pressure in the lungs, also called pulmonary hypertension. A large PDA causes irregular blood flow in the heart and lungs. As
a result, pressure rises in the pulmonary artery. Over time, the increased pressure damages the smaller blood vessels in the lungs. A life-
threatening and permanent type of lung damage called Eisenmenger syndrome may occur.
 Heart failure. Symptoms of this serious complication include rapid breathing, often with gasping breaths, and poor weight gain.
 Heart infection, called endocarditis. A patent ductus arteriosus can increase the risk of infection of the heart tissue. This infection is called
endocarditis. It can be life-threatening.
Patent ductus arteriosus and pregnancy
It may be possible to have a successful pregnancy with a small patent ductus arteriosus. However, having a large PDA or complications
such as heart failure, irregular heartbeats or lung damage increases the risk of serious complications during pregnancy.
Before becoming pregnant, talk to your health care provider about possible pregnancy risks and complications. Some heart medicines
can cause serious problems for a developing baby. Your health care provider may stop or change your medicines before you become
pregnant.
Together you can discuss and plan for any special care needed during pregnancy. If you are at high risk of having a baby with a heart
problem present at birth, genetic testing and screening may be done during pregnancy.

Prevention
There is no known prevention for patent ductus arteriosus. However, it's important to do everything possible to have a healthy
pregnancy. Here are some of the basics:

 Seek early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk
to your health care provider about before you get pregnant. Tell your health care provider about all the medicines you take, including those
bought without a prescription.
 Eat a healthy diet. Include a vitamin supplement that contains folic acid. Taking 400 micrograms of folic acid daily before and during pregnancy
has been shown to reduce brain and spinal cord problems in the baby. It also may help reduce the risk of heart problems.
 Exercise regularly. Work with your health care provider to develop an exercise plan that's right for you.
 Don't drink or smoke. These lifestyle habits can harm a baby's health. Also avoid secondhand smoke.
 Get recommended vaccines. Update your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing
baby.
 Control blood sugar. If you have diabetes, good control of your blood sugar may reduce the risk of certain heart problems before birth.

Nursing Management:
 Decreased cardiac output related to CONGENITAL ACYANOTIC HEART DISEASE evidence by patent ductus
arteriosus.
 Impaired spontaneous ventilation related to metabolic factors (increased metabolic rate, metabolic acidosis) as
evidenced by: decreased pO2, decreased SaO2, and increased pCO2
 Risk for infection evidenced by inadequate primary defenses (immature immune system
 Fluid volume Access refers to an isotonic expansion due to an increase in total body water

 Impaired growth and development related to insufficient fulfilment of body requirement

NURSING CARE PLAN:
Assessment Nursing Nursing Goals Planning Rationale Implementation Evaluation
Diagnosis

1. Decreased To maintain the Assess heart Most patients Assessed heart rate After giving
Subjective Cardiac output cardiac output. rate and have tachycardia and blood pressure care to the
data:- Heart related to blood and significantly patient
rate : Congenital pressure low blood cardiac
145bpm Acyanotic heart pressure in output is
Disease response to maintain
Objective evidence by reduced cardiac
data:- patent ductus output.
Heart arteriosus
Sound :-
Murmur Note skin Cold, clammy, Noted skin color,
color, and pale skin is temperature, and
temperature, secondary to a moisture
and compensatory
moisture increase in
sympathetic
nervous system
stimulation and
low cardiac
output.

Position the An upright Given Position the

child in a position is child in a semi-
semi- recommended to Flower’s position.
Flower’s reduce preload
position. and ventricular
filling when fluid
overload is the
cause; Facilitates
lung expansion.
Administer To decrease Administered
medication as cardiac output and medication as
prescribed: maintain heart rate prescribed

Check for Weak pulses are Checked for

peripheral present in reduced peripheral pulses
pulses stroke volume and including capillary
including cardiac output. refill
capillary Capillary refill is
refill sometimes slow or
absent
Assessment Nursing Nursing Goals Planning Rationale Implementation Evaluation
Diagnosis

2. Impaired growth To fulfill the Assess the Assessment and Assessed the The child
Subjective and development demands of child respiratory status monitoring baseline respiratory status and returns to
data:- related to and continue his and it gets rate and quality of it gets decrease from respiratory
Mother insufficient growth normally. decrease from air exchange. normal that is baseline
says child is fulfilment of normal that is Frequent 58b/min. slowly.
my child body 58b/min. assessment and
will requirement monitoring provides Pulse oximetry
grow normally objective evidence reading
like others. of changes in the remains 96%
quality of oxygen
Objective respiratory effort saturation
data:- Humidified oxygen As per the physicians during
Growth of As per the loosens secretions order oxygen is started treatment.
body may physicians order and helps maintain via hood at
becomes slow oxygen is start via oxygenation status 2lit.flow/min. The child
as nutritional hood at tolerates
requirement is 2lit.flow/min. Medications act Medication is therapeutic
not fulfilled systemically and administered i.e measures with
completely. Medication is locally (on antibiotics(ceftriaxone) no adverse
administer i.e respiratory tissue) as per doctors order. effects.
antibiotics(ceftriaxo to improve
ne) as per doctors oxygenation.
order.
Position facilitates Head up position is
improved condition given to increase the
Head up position is and promotes gas exchange amount.
give to increase the decrease in anxiety.
gas exchange
amount.
Assessment Nursing Nursing Goals Planning Rationale Implementation Evaluation
Diagnosis

3. Impaired Patient Monitor rate, rhythm, Monitor patient’s Monitored rate, After giving
Subjective spontaneous Ventilation is depth, and effort of respiratory secretions rhythm, depth, and care to the
data:- improved respirations effort of respirations patient
ventilation
Respiratory ventilation is
rate..30brea related to Note chest movement, Determine the need Noted chest improved
ths/min metabolic factors watching for for suctioning by movement, watching
(increased symmetry, use of auscultating for for symmetry, use of
Objective metabolic rate, accessory muscles, crackles and bronchi accessory muscles,
data:- metabolic and supraclavicular over major airways and supraclavicular
Child is and intercostal and intercostal
acidosis) as
taking deep muscle retractions muscle retractions
breathing evidenced by:
decreased pO2, Monitor chest x-ray Monitor for Monitored chest x-
decreased SaO2, reports respiratory muscle ray reports
and increased fatigue
pCO2
Routinely monitor Ensure that ventilator Routinely monitored
ventilator settings alarms are on ventilator settings

Monitor the Monitor effects of Monitored the

effectiveness of ventilator changes on effectiveness of
MVon patient´s oxygenation: MVon patient´s
physiological and physiological and
psychological status psychological status

Monitor for adverse ABG, SaO2, SvO2, Monitored for

effects of mechanical end-tidal CO2, adverse effects of
ventilation: Qsp/Qt, A-aDO2, mechanical
infection, barotrauma, patient´s subjective ventilation:
reduced cardiac response infection,
output barotrauma, reduced
cardiac output
Monitor for decrease
in exhaled volume and
Check all increase Checked all
ventilator in inspiratory pressure ventilator
connections Provide routine oral connections
regulary care regulary
Assessment Nursing Diagnosis Nursing Goals Planning Rationale Implementation Evaluation

4. Deficient knowledge To increase the Assess the level of To improve the Assessed the level Knowledge
Subjective (parental) related to level of knowledge knowledge of knowledge for gets increased
data:- feeding of the neonate knowledge related disease. at some level
Parents ask and surgical to care of the Provide health Assists the family to of extension.
about the procedure to correct education related deal with the Provided health
child after surgery
defect.
treatments of performed. to disease physical and education on care
child. psychosocial aspects on cleftlip and
Explain surgical of a child with a palate child.
Objective procedure and congenital defect.
data:- expected outcome. Explained aall the
By asking Show pictures Eliminating unknown outcomes to the
frequent of other factors helps parents so that
question to decrease anxiety.
children’s cleft lip anxiety becomes
parents have repair. less and shown
lack of other childs
knowledge Demonstrate Provides visual
feeding techniques instructions. Explained that
and alternatives. Redemonstration nebulization is
Allow parents to confirms learning. helpful for
demonstrate before clearance of airway
discharge. and easy
respiration.
Explain care
and treatment
(both short term
and long term).

Discuss
potential
complications.
 Assessment Nursing Diagnosis Nursing Goals Planning Rationale Implementation Evaluation
5. Fluid volume Access The infant will Review the Such information can assist to the patient’s The infants
Subjective refers to an isotonic be patient’s direct management. History history to fluid volume is
Data :- Child is expansion due to an nonmonomeric history to may include increased fluids or determine the maintained
not taking increase in total body as evidenced by determine the sodium intake. probable cause of
enough feeding
water urine output probable cause the fluid
Objective Data:-
greater than or of the fluid imbalance.
Child having equal to 30 imbalance.
Difficulty in mL/hr.
swallowing
Monitor Sudden weight gain may mean Monitored weight
weight fluid retention. Different scales regularly using
regularly using and clothing may show false the same scale
the same scale weight inconsistencies. and preferably at
and preferably the same time of
at the same day wearing the
time of day same amount of
wearing the clothing.
same amount
of clothing.
Sinus tachycardia and
Monitor and increased BP are evident in the Monitored and
note Blood early stages. note Blood
pressor and pressor and Heart
Heart rate. rate.

These signs are caused by an

Assess for accumulation of fluid in the Assessed for
crackles in lungs. crackles in
the lungs, the lungs,
changes in changes in
respiratory respiratory
pattern, pattern, shortness
shortness of of breath, and
breath, and orthopnea.
orthopnea.
These assessment findings are
signs of fluid overload.
Assess for Assessed for
bounding bounding
peripheral peripheral pulses
pulses and S3. Significantly increased and S3.
response to diuretics may lead
Check for to a fluid deficit. Checked for
excessive excessive
response response
to diuretics. to diuretics.
HEALTH EDUCATION:
 Explain about surgical management to the parents
 Explain about Residual shunt present and position of the device
 Demonstrate surgical wound care.
 Show proper feeding techniques and positions.
 Explain about importance of Immunization
 Teach about different feeding technique

CONCLUSION:
Patient’s evaluation: baby condition is improving slowly the result is good then the previous
condition at the time of admission. And prognosis is also good for patent ductus arteriosus
Self-evaluation: Specific Learning accomplished through this study.
BIBLIOGRAPHY:
1.B.T.Basavanthappa,”NURSING THEORIES”,1st edition, Jaypee brothers medical
publishers,2007,New Delhi
2. Dorothy R. Marlow, Barbara A Redding,”TEXTBOOK OF PEDIATRIC NURSING”, 6th
edition, elsvier, New Delhi.
3. Marilyn J.hockenberry, David Wilson,”WONG’S ESSENTIALS OF
PEDIATRIC NURSING”, 8th edition, New Delhi.
4. O.p.Ghai, V.K.Paul, “GHAI ESSENTIAL PEDIATRICS”,5th edition, Mehta
publishers,2003,New Delhi.
5. Piyush gupta,”ESSENTIAL PEDIATRIC NURSING”, 2nd edition,CBS publishers and
distributors,2007,New Delhi,banglore.